What is Tietze syndrome?

Tietze syndrome is an uncommon condition that results in chest pain due to swelling of the cartilage where the ribs meet the sternum.¹ The most commonly affected ribs are the first and second ribs high up, which is why there is chest pain. This pain can be wrongly thought to be a heart attack. However, this pain does not stay confined to the chest area; instead, it can spread up towards the arms and shoulders. The cause of the swelling is not exactly known, it may be due to minor injuries, repeated strain or inflammation. Over time, Tietze syndrome resolves on its own, with treatment advice for the patient to rest and take painkillers regularly until the pain has reduced. In some cases, if the above-recommended treatment does not work, physical therapy may also be needed.

Why is diagnosis important?

It is important to get a diagnosis to rule out something more sinister due to the presence of chest pain. It is essential to rule out disorders like a heart attack. Also, Tietze syndrome has very similar symptoms to costochondritis which causes a sharp pain in the chest due to the ribs connecting with the bones in the middle of the chest. Sometimes Tietze syndrome can be mistaken for costochondritis, however, the key difference is Tietze syndrome has swelling amongst the ribs which is not seen in costochondritis.² An informed and accurate diagnosis can lead to the correct treatment plan while avoiding additional, uncomfortable tests. Furthermore, knowing the symptoms are not caused by something life-threatening can reduce stress for the patient. 

Symptoms of Tietze syndrome

The most common symptoms of Tietze syndrome include the following:³

• Chest pain - this pain starts around the sternum. It is usually a sharp pain only on one half of the chest
• Radiating pain - while the does initially start on one side of the chest, it can spread to the shoulders and arms
• Swelling - usually present in the area where the ribs join the sternum (a characteristic sign of Tietze syndrome). This area may also be quite tender and painful

Why is Tietze syndrome different from other disorders?

Two distinct characteristics separate Tietze Syndrome from other disorders like costochondritis and heart attacks:

• The first of the two characteristics is swelling. In contrast to costochondritis, Tietze syndrome has observable swelling where the ribs are⁴ 
• The second distinct characteristic is pain that spreads and increases when moving, taking deep breaths and coughing. This radiating pain can be used to distinguish between Tietze syndrome and heart attacks. Pain caused by the heart is constant and remains relatively the same. Heart attacks are also commonly linked to additional symptoms such as sweating, dizziness and shortness of breath, all of which are not usually associated with Tietze syndrome

These differences make this condition easier to diagnose and treat.

Clinical evaluation of Tietze syndrome

To reach a diagnosis of Tietze syndrome, doctors normally begin by taking the medical history of the patient. This is done by asking a series of questions which will be highlighted below. Once a detailed medical history has been provided, the healthcare professional will perform a physical examination. Both of these together allow a better understanding of the symptoms and help to rule out other potential causes.⁵ 

What kind of questions may you be asked for a medical history?

To get a better picture of your symptoms, you may expect a couple of the below questions to be asked (this is not an exhaustive list, there may be further questions not listed):

• When did you first notice the pain? - this helps to understand if this is a sudden pain or a slow, growing pain
• Does the pain get worse with particular movements or pressure? - If movement and pressure causes the pain to become worse then this signifies that pain is more likely to be caused due to the ribs and not the heart
• Has there been any recent injuries or continuous/excessive strain on your chest? - Any recent injury or physically demanding activities can cause strain on the ribs/chest causing pain 
• Have you experienced any form of infection or illness recently? - This could contribute to the swelling seen
• Do you suffer from any inflammatory disorders? - Inflammation could cause pain and swelling seen in Tietze syndrome 

What to expect in a physical examination?

Once the healthcare professional has a detailed medical history, they will move on to carrying out a physical examination:

• The doctor will look at different areas of your chest and ribs by pressing down on particular areas, they do this to check for any soreness and swelling. If there is pain when pressing in a certain area, it gives the doctor a better idea of what the cause of the pain is e.g. the pain could be from the heart, the lungs, or the ribs
• The doctor may want to look at how the pain changes with movement, so you may be asked to take a deep breath or move your arms to measure changes in the severity of your pain. If the pain does get worse with these movements, then it is more likely to be Tietze syndrome and not a problem with the heart

Diagnostic criteria 

To diagnose Tietze syndrome, the following symptoms are assessed:⁶

• Pain in the chest, specifically where the ribs join the sternum
• Pain that increases when moving or with pressure (e.g. taking a deep breath) that is not caused by the heart or lungs
• Swelling near the chest/ribs

In addition to checking for the presence of the above symptoms, a part of the diagnostic criteria is also ruling out the possibility of other related conditions such as:

• Heart disorder like heart attack or angina, is tested through an electrocardiogram or blood tests
• Lung conditions such as pneumonia or lung infections, are tested for by conducting a chest X-ray
• Inflammatory illnesses like arthritis are checked for through blood tests

Further tests and imaging

Diagnoses are usually made through exploring the patient’s history and examining symptoms. However, in some cases, further tests can be done like scans and blood tests. 

• X-rays can check for any fractures or infections in the lungs which could be an alternative explanation for the pain
• Magnetic resonance imaging (MRI) can be done to have a closer look at the swelling and inflammation internally
• A computed tomography (CT) scan can be done to check for any other abnormalities like a tumour that could be contributing to the symptoms

When to get medical attention?

Although Tietze syndrome is not an immediate threat to life, as there is chest pain present, it is best to get medical attention if the following is present:

• Severe, sudden chest pain that spreads towards your arms/neck/jaws as this could be something more serious 
• Pain that stays and worsens for a long period of time despite rest and the use of painkillers
• If there is swelling that does not go down, then it is best to get checked out by a medical professional to find out the cause 

Summary 

Tietze Syndrome is a rare but manageable condition that affects the upper ribs and sternum. While it is not life-threatening, it can cause significant discomfort and may be mistaken for more serious conditions, such as heart disease or lung infections. Accurate diagnosis is essential to ensure that individuals receive the appropriate treatment and to rule out other potentially dangerous conditions.

Although Tietze Syndrome does not have a single definitive test for diagnosis, a combination of clinical evaluation, imaging, and blood tests can help confirm the condition while excluding other causes of chest pain. Treatment typically focuses on managing symptoms through pain relief, anti-inflammatory medications, and lifestyle modifications, such as avoiding activities that worsen the pain.

Understanding the symptoms and seeking timely medical attention are key to effective management. If chest pain is severe, persistent, or associated with swelling, a medical evaluation is necessary to determine the underlying cause. While Tietze Syndrome can be uncomfortable, most people find relief with conservative treatment, and symptoms often improve over time. Raising awareness of this condition can help individuals and healthcare providers recognise it early, preventing unnecessary worry and ensuring appropriate care.